Healthcare Associated
Infections (HAI Project)
CAUTI’s
(Insert your hospital name)
In Partnership with IPRO
Date
CMS
 Leads a national healthcare quality improvement program,
implemented locally by an independent network of QIOs in
each state and territory.
IPRO
 The federally funded Medicare Quality Improvement Organization
(QIO) for New York State, under contract with the Centers for
Medicare & Medicaid Services (CMS).
 IPRO provides a full spectrum of healthcare assessment and
improvement services that foster the efficient use of resources
and enhance healthcare quality to achieve better patient
outcomes.
2
The QIO Program
 Largest federal program dedicated to improving health
quality at the local level,
 Trustworthy partners for the continual improvement of
healthcare for all Americans,
 Focuses on three broad aims:
 Better patient care,
 Better population health,
 Lower healthcare costs through improvement.
3
As the QIO for New York State, IPRO works to achieve the
goals of the national QIO Program by:
• Convening communities of providers, practitioners, and
patients across the state to:
• Share knowledge
• Spread best practice
• Achieve rapid, wide-scale improvements in patient
care
4
Improving Individual Patient Care
Reducing Healthcare-Associated Infections (HAI’s)
HAI-Overview
APIC Statement on the Cost of Hospital-Associated
Infections1
• 2 million patients per year
• ~90,000 deaths
• $4.5-$5.7 billion per year in patient care costs
HAI - Overview
HAIs rank in the top 10 leading causes of death
in the US2
7
From the Organization’s Perspective
HAIs harm the bottom
line
• Hospital-acquired
conditions lead to loss
of revenue.
8
National Healthcare Safety Network
NHSN Data Collection
• The NHSN will become the
national repository of data
• The infection prevention department is usually responsible
for reporting data into NHSN
• Data will be available on a facility, state, and national level
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Improving Individual Patient Care
Catheter Associated Urinary Tract Infections
CAUTI’s
CAUTI – Background
An estimated 1 in 4 hospitalized patients received an
indwelling urinary catheter in 20034
• ~50% of these indwelling urinary catheters are unnecessary5
• CMS designates CAUTI as a “never event”
• Medicare Modernization Act of 2003
• Deficit Reduction Act of 2005
• As of Oct. 1, 2008, no CMS reimbursement
• 2007 study showed 12,185 CAUTIs costing
$44,043/hospital stay6
• 2012 National Patient Safety Goal
• Focuses on CAUTI evidence based prevention for indwelling catheters in
hospital and critical access hospital accreditation programs
11
CAUTI – Background
CAUTI Characteristics:
• Most common site of HAI.
• Almost all are caused by instrumentation
CAUTI Complications:
• Discomfort
• Prolonged hospital stay
• Increased cost
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CAUTI Goals
Measure
Project Target
CAUTI Relative
Improvement Rate
≥25% Reduction
Urinary Catheter
Utilization Rate
Relative improvement
of 10% or greater
13
Sources for CAUTI Guidelines
Sources for CAUTI Guidelines
APIC - Association for Professionals in Infection
Control and Epidemiology
http://www.apic.org/Resource_/EliminationGuideForm/c0790db8-2aca4179-a7ae-676c27592de2/File/APIC-CAUTI-Guide.pdf
HICPAC - Healthcare Infection Control Practices
Advisory Committee
http://www.cdc.gov/hicpac/cauti/001_cauti.html
SHEA - Society for Healthcare Epidemiology of
America
http://www.jstor.org/stable/pdfplus/10.1086/591066.pdf?acceptTC=true
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APIC Guideline Examples
• Use indwelling catheters only when medically necessary
• Allow only trained healthcare providers to insert
catheters
• Maintain a sterile closed drainage system
• Properly secure catheters after insertion to prevent
movement and urethral traction
• Maintain drainage bag below level of bladder at all times
• Remove catheters when no longer needed
• Document indication for urinary catheter on each day of
use
• Use reminder systems to target opportunities to remove
catheters
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HICPAC Guideline Examples
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SHEA Guideline Examples
• Ensure that trained personnel insert catheters
• Practice hand hygiene
• Evaluate necessity of catheterization
• Review ongoing need regularly
• Use smallest gauge catheter possible
• Use barrier precautions for insertion
• Perform antiseptic cleaning of meatus
• Maintain a sterile, closed draining system
• Replace system if a break in asepsis occurs
• Empty the collecting bag regularly, using a separate
collecting container for each patient, and avoid allowing
the draining spigot to touch the collecting container
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References
1. APIC Cost of Hospital-Associated Infections Model.
2.
3.
4.
5.
6.
http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Guidelines
Standards/APICCostCalculator-Lit051011.xls
Klevens RM, Edwards JR, Richards CL, et al. Estimating healthcareassociated infections and deaths in U.S. hospitals, 2002. Public Health
Rep. 2007; 122:160-167.
http://www.cdc.gov/ncidod/dhqp/pdf/hicpac/infections_deaths.pdf
Perenchvich EN, et al. Raising Standards While Watching the Bottom Line:
Making a Business Case for Infection Control. Infect Control Hosp EPID
2007; 28:1121-1133
Smith JM. Indwelling catheter management: from habit-based to evidencebased practice. Ostomy Wound Manage 2003;49:34-45.
Gokula RM, Hickner JA, Smith MA. Inappropriate use of urinary catheters
in elderly patients at a midwestern community teaching hospital. Am J
Infect Control 2004;32:196-199.
Wald HL, Kramer AM. Nonpayment for Harms Resulting From Medical
Care. JAMA 2007;298: 2782-2784.
What we do here (hospital name)
Our current urinary catheter policy is:
Outline your policy and clearly state what is
expected.
• Who can insert a urinary catheter?
• Is a check list followed?
Is you existing policy in agreement with
published guidelines
• Review current guidelines and compare them to your current
policy. Consider updating, as appropriate
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Our current urinary catheter procedure is as
follows:
Outline your procedure and discuss any
areas you have identified that are
in and out of compliance
• Does your policy address catheter removal? Do you verbally ask
the attending physician if the catheter can be removed on a daily
basis?
• Is training a component of your procedure?
22
Our current results are as follows:
Outline your results and provide any graphs
and data to demonstrate where you were when
you began your CAUTI project and where you
are now. Use run charts to display data over
time.
Include any interventions which have
contributed to improving care and/or modifying
procedures.
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Our Procedure is as follows:
After discussing your policy and procedure, ask
you staff the following two questions:
•Please describe how you think the next patient
with a urinary catheter will be harmed.
•What can be done to prevent/minimize harm?
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Our Improvement Plan is as follows:
Outline the next steps for your organization to
improve or
“hold the gains”.
Has this project been spread to the entire
organization? If not, do you have a target data to
move the project house-wide?
If no, consider setting a date
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This material was prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the
Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents
do not necessarily reflect CMS policy. 10SOW-NY-AIM7.1-12-10
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Contacts for the HAI Project
IPRO Contacts
Karline Roberts
(518) 320-3508
kroberts@nyqio.sdps.org
Bill Gardiner
(518) 320-3505
wgardiner@nyqio.sdps.org
Crystal Isaacs
(516) 209-5589
cisaacs@nyqio.sdps.org
Chad Wagoner
(518) 320-3552
cwagoner@nyqio.sdps.org
Teré Dickson, MD
tdickson@nyqio.sdps.org
(516) 209-5324
Hospital Contacts
Fill in the names of your hospital
contacts